A new study finds that internists make the correct diagnosis in only 55 percent of simple illnesses, and in just 6 percent of complex cases.

DOCTORS FREQUENTLY MAKE THE WRONG DIAGNOSIS

When we see our doctor because we are sick, most of us expect that we will leave his or her office with a reasonably accurate diagnosis, and the appropriate treatment recommendations for our illness. However, a newly published clinical research study suggests that these expectations might be rather unrealistic, particularly if we are suffering from an illness that requires a reasonably complex evaluation by our physician. This new clinical study appears in the current issue of JAMA Internal Medicine.

In this study, 118 general internists were recruited from throughout the United States. All of these physicians were asked to provide a diagnosis for 4 previously validated patient scenarios, including both straightforward and complex clinical cases. These doctors were asked to provide their diagnoses after reading the histories, physical examination findings, general diagnostic testing results, and disease-specific testing results for each of these 4 cases.

The results of this clinical study were not exactly reassuring to prospective patients…. The 118 participating internists came up with the correct diagnosis for only 55 percent of the straightforward cases. When it came to making the correct diagnosis for the more challenging patient scenarios, the physician-volunteers in this study correctly diagnosed only 6 percent of the more complex clinical cases! Moreover, the doctors who participated in this web-based clinical study appeared to have little insight into their diagnostic shortcomings, as their very high level of confidence in their diagnoses was similar for both the straightforward cases and the more complex cases. This latter finding led the study’s authors to question whether or not physicians who are dealing with complex patient cases realize how likely their diagnosis is to be wrong. (If a physician is unaware that his or her diagnosis is very likely to be wrong, then they may miss an opportunity to perform a more in-depth evaluation of their patient.)

While this is a small pilot study, its findings are nonetheless quite disturbing. It suggests a simultaneous lack of diagnostic accuracy and over-confidence on the part of at least some physicians when it comes to evaluating patients, arriving at a correct diagnosis, and (hence) prescribing the correct treatment. Whether or not the findings of this small study can be generalized to all internists (or to all doctors in the United States) is not clear. However, the disconcerting findings of this clinical study should serve as a red flag to physician residency training programs and physician certification boards. Meanwhile, becoming an educated healthcare consumer, and asking your physician to explain his or her assessment to you, may be just what the doctor ordered!

According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent. A new website, Veterans in Healthcare, seeks to connect veterans with potential employers. If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.

Disclaimer: As always, my advice to readers is to seek the advice of your physicianbeforemaking any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

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